The tale of city mouse and the country mouse revealed to many of us as children the wide gulf that can exist between urban and rural life.
Farm country is heralded for its simplicity, beauty and community focus, but it also harbors its own problems – ones that Indiana's upgraded Medicaid program, known as the Healthy Indiana Plan, is doing a lot to address.
Rural communities are going through some tough times. They represent more than 40 percent of the state's population but haven't seen their fair share of economic benefits.
In fact, only those Hoosier counties with more than 250,000 residents have seen net employment growth within a generation. Poverty is an issue, and so is the aging population. Then there are the ravages of the opioid and methamphetamine crises. All of these factors sit on top of inherent characteristics of rural life, such as low population density, that mean medical centers can be few and far between.
These elements make rural health care a challenge and a calling. Rural health care providers have to find ways to meet unique issues while innovating to address local patients' needs.
As we struggle to attract and retain physicians, many of whom are drawn away to the big city's amenities, we must also figure out how to address transportation issues that can keep seniors, the disadvantaged and the medically fragile from care.
While we worry about our budgets breaking from the costs of uncompensated treatment for the uninsured, we must do our part to help those suffering from addiction and age-related disease.
Fortunately, Indiana recognized the central role of Medicaid in all of this. At the most basic level, the uninsured rate is a key factor affecting the survival of Indiana's 35 critical-access hospitals and 67 rural health clinics. Indiana was facing a coverage gap in rural areas approaching 75,000 people, and this was a key pressure point. Lack of health insurance was costing an estimated $800 million a year statewide. The Healthy Indiana Plan took direct aim at these issues.
When people lack health insurance, they put off going to the doctor. Medical conditions get out of control, and ultimately rural medical providers see very sick people in the emergency room. Much of the time, those bills never get paid. By cutting Indiana's uninsured rate to less than 10 percent for the first time, the Healthy Indiana Plan helped relieve budget shortfalls so “safety net” hospitals can remain open.
The difference is not just that the Healthy Indiana Plan pays for care. It's also that patients are more likely to get the right care. That means preventive measures, early detection of disease, effective treatment for chronic conditions and other efforts that keep people out of the hospital. Although it sounds expensive, appropriate care is actually less expensive in the long run.
There is also the benefit of substance abuse treatment. As long as addiction is rampant, Indiana will only see increases in HIV, hepatitis and other diseases. This will cost the government and our health care system dearly unless we can battle back. The Healthy Indiana plan is helping by covering drug rehab programs for those who need them most.
Perhaps most importantly, Indiana's Medicaid implementation is unleashing providers' creativity to solve rural health care problems. Telemedicine is overcoming distance barriers and making health care expertise available in schools and other community-based settings– valuable when the nearest medical provider could be 35 miles away. Indiana legislators have noticed the power of this option and are considering ways to increase its use under Medicaid.
Rural health providers are striving to remain in the communities we serve. The Healthy Indiana Plan, which state leaders continue to refine, is making it easier to achieve our mission of delivering better, more cost-efficient, more patient-centric care. Overhauling Medicaid has been a large but worthwhile undertaking. Indiana should build on this progress so rural Hoosiers can enjoy the health care they deserve.
Don Kelso is executive director of the Indiana Rural Health Association.